EFFECT OF ANTIHYPERTENSIVE THERAPY WITH RILMENIDINE ON COGNITIVE FUNCTION IN ELDERLY HYPERTENSIVE PATIENTS

Aim.  To assess antihypertensive efficacy of rilmenidine (Albarel, EGIS, Hungary) and its effect on cognitive function in elderly hypertensive patients. Material and methods. 30 elderly (in average 68 y.o.) hypertensive patients were observed. Each patient received therapy with rilmenidine 2 mg daily during 6 months. 24 hours monitoring of blood pressure before and after therapy was done in each patient. In order to assess cognitive disorders all patients passed neuropsychological tests, which allowed revealing damages of memory, attention, concentration, mental efficiency and psychomotor functions. Raten tests, Veksler test, vocal activity, memory (10 words), serial counting and kinetic probes were used. Results. After 24 weeks of monotherapy with rilmenidine, decrease in daily average systolic blood pressure (SBP) by 7.2% (p<0.01) and diastolic blood pressure (DBP) by 5.5% (p<0.05) was observed. Therapy with rilmenidine showed decrease in daily average burden by SBP and by DBP (by 25.3% and 18.8% respectively; p<0.05) and daily average time index of hypertension for SBP and DBP (by 32.5 and 60.6% respectively; p<0.05) According to the results of neuropsychological tests at the end of treatment, average time for Raten test completion decreased by 16.7% (p<0.05), and for Veksler test completion – by 15.6% (p<0.05). At the same time significant increase in vocal activity of patients is noted: number of words at free associations tests, verbs and plants denomination have grown by 5.8%, 5.1% and 6.3% respectively (p<0.05); number of mistakes in these tests decreased respectively by 71.4%, 50% and 33.3% (p<0.05). Positive dynamics in characteristics of memory: number of words at first and last immediate and postponed reproduction increased respectively by 36.4%, 21.6% and 14.1% (p<0.05),  average time of serial counting and average time of memorization decreased respectively by 13.2% and 31.8% (p<0.05). Velocity in both hands increased, which was observed both in tests on grip and fingering, and on reciprocal coordination. Conclusion. Well-defined antihypertensive effect of rilmenidine in elderly AH patients is accompanied by significant improvement of cognitive functions. This greatly expands opportunities of treatment with rilmenidine in this age group.

1. Остроумова О.Д,. Корсакова Н.K., Баграмова Ю.А. Деменция и артериальная гипертензия у пожилых больных: возможности препарата Физиотенз. РМЖ 2002;10(1):7–10.

2. Michael S. Mega, M.D, PhD. Differential Diagnosis of Dementia: Clinical Examinations and Laboratory Assessment. Clin Cornerstone 2002;4(6):53–65.

3. Skoog I, Lernfelt B, Landahl S, et all. 15–year longitudinal study of blood pressure and dementia. Lancet .1996;347(9009):1130–1.

4. Elias M.F, Wolf P.A, D`Agostino, et all. Untreated blood pressure level is inversely reated to cognitive functioning: the Framingham Study. Am J Epidemiol 1993;138(6):353–64.

5. Tzourio C, Dufouil C, Ducimetiere P, et all. Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging. Neurology 1999;53(9):1948–52.

6. Ruitenberg A., Skoog I., Ott A., et all. Blood pressure and risk of dementia: results from the Rotterdam study and the Gothenburg H–70 Study. Dement Geriatr Cogn Disord 2001;12(1):33–9.

7. Launer L.J., Masaki K., Petrovitch H., et all. The association between midlife blood pressure level and late–life cognitive function. The Honolulu–Asia Aging Study. JAMA 1995;274(23):1846–51.

8. Prince M.J., Bird A.S., Blizard R.A., et all. Is the cognitive function of older patients affected by antihypertensive treatment? Results from 54 month of the Medical Research Council`s trial of hupertension in older adults. BMJ, 1996;313(7050):166–7.

9. Applegat W.B., Pressel S., Wittes J., et all. Impact of treatment of isolated systolic hypertension on behavioral variables. results from the systolic hypertension in ederly program. ACP J Club. 1995;122(2):35.

10. Суслина З.А., Гераскина Л.А., Фонякин А.В. Особенности антгипертензивной терапии при цереброваскулярных заболеваниях. Клин фармакология и терапия 2002; 11: 1–5.

11. Forette F., Seux M.L., Staessen J.A., et all. Prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst–Eur) study. Arch Intern Med 2002;162(18):2046–52.

12. Randomised trial of a perindopril–based blood–pressure–lowering regimen among 6105 inviduals with previous stroke or transient ischaemic attack. PROGRESS Collaborative Group.Lancet 2001;358:1033–41.